MIDLANDS AIDS

CARING

ORGANIZATION

STRATEGIC PLAN

Contact Person: Darlington Changara (Director)

Physical address: 817 Goddard Road, Zvishavane Zimbabwe

Phone Number: 263 51 4199

Telefax: 263-51 3950/3029

Email address: director@maco.co.zw/macodirector@gmail.com

INTRODUCTION Midlands AIDS Caring organization is a registered welfare organization based in

Zvishavane Town working in the Midlands Province. The organization went though a

participatory strategic planning process that brought together staff, volunteers,

government departments, community leaders and clients to critically review where the

organization came from , the current environment and where the organization is going

in the next five years

This strategy shall guide programme implementation, shall be a tool used by all the

governance structures to monitor and perform their roles. It is also going to be used to

mobilize resources for the organization. All staff members, volunteers, board members,

current and potential donors should be assisted to know this document so that they can

all contribute to the achievement of the organizational objectives

ORGANIZATIONAL BACKGROUND Midlands AIDS Caring Organisation (MACO) was established in 2002, as a community

response to the challenges that had been poised by HIV and AIDS with the aim of

making a difference in lives affected and infected by HIV and AIDS using the resources

that are inherently available in communities and where necessary creating an

environment where these resources can be developed and nurtured. The organisation

works with communities in Mberengwa and Zvishavane Districts of Midlands Province to

prevent the spread of HIV, support and care for those infected/affected and ease the

impact of HIV on families and communities. The organisation recognizes and supports

the active involvement of people living with HIV and AIDS in its community programmes

and on its Board as a core strategy to ensuring stronger and relevant community

responses to the epidemic.

SITUATIONAL ANALYSIS Macro environment Twenty three years after the first HIV and AIDS case in Zimbabwe, the epidemic has

matured and we have witnessed the dynamic changes in the HIV environment. To date

it is estimated that over 40 million people live with the virus throughout the world;

almost three quarters of these people are in Sub Saharan Africa, the region that

contributes less than 10 % of the world’s population. There has been debate as to why

Southern Africa is the epicenter of the epidemic. A lot of research and discussion have

happened and some major drivers of the epidemic in the region. The current food crisis

in the whole world has impacted negatively on the lives of the poor. Poverty levels

among the poor are increasing due to the food crisis which has also been worsened by

ever increasing oil prizes and the prize of food in general. Most countries in the world

have economic challenges that makes support vulnerable people limited. People living

with HIV and AIDS have not been spared of this development. In the macro

environment there are so many changes that have affected the way we do business as

developed agencies

Economic Changes

Hyperinflation has affected our operations in that it is difficult to plan and budget for

activities. The prizes of basic commodities continue to rise which makes it unaffordable

for the vulnerable communities. The use of multiple exchange rates has also distorted

people to travel from rural areas to towns either to buy basic commodities or to seek

services. Government to government agreement are being affected by foreign policies

and political relationships which have resulted in limited resources channeled toward

poor nations

Social and cultural Changes

Disruption of families due to rural urban migration, cross boarder trading and

movement of people from one country to another in search of employment especially in

Southern Africa. The above scenario has created a situation where spouses live in

separation, children are staying on their own or with grand parents who may not be well

enough to run around looking for food

The climatic changes have also affected the rain patens in Southern Africa which directly

impacts negatively the agricultural production in the region resulting in hunger and

poverty. Most people cannot afford a decent meal let alone feed their children. This

affects clients who are on medication particularly those that are supposed to take

medication after a meal

Health Changes

The issue of access to health services particularly for poor Nation has contributed to

high infection and mortality world wide. The high turnover of health professionals

moving from one country in search of greener pastures, shortage of drugs and other

equipment required on medical diagnosis and the high cost on health services have

limited access to health services by the poor. Poverty and hunger are also major

contributing factor that affects drug compliance to many clients in the developing

world. Transport costs also affect access to health services when individuals find it

difficult to travel to urban centers in search of health services

Technological changes

The introduction if email, internet and cell phones have improved communication in

general from one country to another. People can now communicate easily and

contribute to the advancement of their lives by making decision about their lives and

can consult others easily. However access to these facilities remains a dream to rural

communities particularly in Africa. Southern Africa is also experiencing electricity supply

challenges at the moment that have seen communities spend hours without electricity

thereby disrupting their business and social life. This scenario have also affected the

health delivery system in that the blackout sometimes affects health facilities in one

way or the other

Micro environment

In order to analyze the micro environment it is important to look at MACO’s major

achievements. Challenges over the years

Achievements

Achievements and challenges faced by MACO as an organization in the last 5 years

1. Creation of data base for all people who are chronically ill.

2. Formation of youth and kids clubs.

3. Established voluntary counseling and testing in collaboration with PSI.

4. Documentation of all activities

5. Training of HBC facilitators in Zvishavane Urban

6. Now on Website

7. Retention of donor funding

8. Staff retention

9. Acquisition of a stand

10. Computerized accounting packages

11. Strong networking partnerships

Challenges

1. Transport- vehicle is congested but managed to acquire a bike from Care also

DAAC and other ASOs provide transport when need arises.

2. Drugs shortages-the organization opened an account with Tee’s pharmacy to

acquire drugs for its clients but the costs are now too high.

3. Political challenges leading to suspension in field activities

4. HBC facilitation lacking facilities

5. Partners not funding Admin component from 2004 backwards

6. Predictability of funding

THE HIV AND AIDS SITUATION

World wide

According to UNAIDS / WHO in July 2008 and referring to end of year 2007. There are

330 million people world wide who are living with HIV and AIDS of which 30.8 million

people are adults, 15.5 million are women and 2.0 million people are children. In 2007

alone 2.7 million people were newly infected by HIV of which 37 million are children.

2.0 million People died in 2007 due to HIV and AIDS and among them 27 million were

children

More than 25 million people have died of AIDS since 1981 Africa has 11.6 million

orphans as a result of HIV and AIDS. At the end of 2007, women accounted for 50% of

all adults living with HIV worldwide and for 59% in Sub –Saharan Africa Young people

under 25 years old account for half of all new HIV infections and transitional countries

9.7 million people are in immediate need of life saving AIDS drug, of these only 2.99

million 31% are receiving the drug

Sub Saharan Africa

In the region, it is estimated that 22 million adults and children are living with HIV at the

end of 2007. During the year 2007 an estimated 1.5 million Africans died from AIDS and

the epidemic has left behind some 11.6 million orphans. This makes the region the

epicenter of the epidemic

In Zimbabwe

Ministry of health and Child Welfare released the new prevalence rate. The new rate

shows that there is a steady decline from 18.1 percent to 15.6 percent over the last four

years. This is encouraging particularly given the fact that Zimbabwe had very little

resources made available in the fight against HIV and AIDS. About 1,3 million people are

living with HIV and AIDS and 260 000 are in urgent need of anti- retroviral medication

while only 86 000 are currently on ARVs treatment . The above information shows us

that more and more clients or people are being cared for at home and due to

movement of health professionals in search of greener pastures and shortage of drugs

and other equipments in our health facilities, the burden of care is going to the

responsibility of families of which women will be the major players. In the next five

years the number of people who needs to be cared for in the home is going to increase

and families need to be empowered to be able to cope with illness. The region,

Southern Africa recently carried out a research on why the region is hardest hit by HIV

and AIDS and identified the following as the major drivers of the epidemic.

a) Concurrent multiple partnerships

It emerged that generally concurrent partnership is a major driver of the epidemic. The

type or form of this relationship takes different forms

Sugar daddy, sugar mummy type

An economic and material relationship

Fashionable permanent relationship among married people

b) Intergenerational sexual relationships

This type of relationship is mainly based on economic material benefits

c) Cultural and religious beliefs

d) Gender in balance

e) Commodities, business and holidays

These practices affect people from the age of 15 years and above. While the situation is

like that, it also emerges that since the first case of the epidemic more resources have

been put in the vulnerable groups like youths in school, commercial sex workers and

truck drivers. There is a gap in addressing the above factor in the region

Zimbabwe has developed a new behaviour change strategy through the multi-sectorial

approach that looks at the major drivers of the epidemic. In the new strategy

communities at ward level are supposed to be guided by the National strategy and

develop wards action plans that they implement, monitor and evaluate through

behavior change forums. This strategy is in place until 2011. The number of orphans

and vulnerable children is increasing everyday; organizations need to focus on

empowering communities to be able to cope with this growing problem. The focus

should be on psychosocial support, education, health, nutrition, hygiene, food shelter

acquisition of birth certificates, vocational training, survival skills and water and

sanitation. The department of social welfare in partnership with UNICEF has put in

place a National plan of Action which guides the National response to the growing

orphans and vulnerable children programme of which organizational strategies should

fit in

The issues of access to treatment are a major one. The number of clients who urgently

need ART treatment compared to those that are already on treatment leaves a lot to be

desired. The main issue is not access to treatment only but the levels of knowledge on

treatment issues and community treatment preparedness issues, The expanded

support programme has enhanced the treatment programme but a lot needs to be

done. Voluntary counseling and testing has been widely accepted in Zimbabwe, over 1

million people have gone through voluntary counseling services in Zimbabwe. More and

more people particularly those that stay in rural areas need services and they can only

be reached through outreach services. After analyzing the macro environment, the

following areas came out as issues or problems that are going to exist in the community

in the next five years

1. Orphans and vulnerable children

The number of OVC is going to increase as well as the nature of issues or challenges

facing them

2 The number of people who are ill/ sick and are looked after at home is still going to be

high. The caregivers need support in terms of information, knowledge and skills on how

to cope with illness

3. Although the HIV prevalence is going down, 15% is still too high, we still have new

infections taking place, focus should be on behavior change working through the major

drivers of the epidemic guided by the National behavior change strategy

4. Poverty

Close to 80% of the rural communities in Zimbabwe are living below the poverty datum

line and poverty is also worsened by cultural/ regional and gender imbalances in terms

of the impact. It is therefore necessary to empower the vulnerable economically to

reduce poverty levels and assist them change the practice that pre- dispose people to

HIV and AIDS

5. Water and sanitation.

The supply of clean water and sanitary facilities to PLWHA, orphans and vulnerable

children and those that are looking after them is key if intervention have to achieve

anything. This is a cross cutting issue that need to be packaged in all interventions

STAKEHOLDERS’ ANALYSIS

Identifying what other stakeholders who are doing the same programs done at MACO in

the same catchment’s area are doing.

A. OVC

Organization Activities Gap MACO -HIV prevention

-Educational assistance -Sporting activities -Life skills -ART literacy

Coverage limited No shelter for MACO

Betserenayi -Educational assistance -Shelter -Health and spiritual support

No livelihood

Save the Children -Child protection -Educational assistance -Junior councils

No livelihood

Care -Educational assistance -Nutritional support -Pass on livestock -Birth certificates

No livelihood

World Vision -Spiritual support -Educational support

No livelihood

Bethany -Educational support -Psycho-social support -Infant feeding

No livelihood

B. HBC

Organization Activities Gaps MACO -Palliative care

-Medical treatment -Workshops -Visits -Program on wills and inheritance

Water and sanitation not included No budget for support groups

LDS -Nutritional support Inconsistent

Red Cross -HBC Coverage is limited Office managed by volunteers

Betserenayi HBC,VCT,ART,CD4 machine In Mberengwa district only

Ministry of ART,VCT,OI,PPTCT Erratic drug supplies

Health& Child welfare

Hospital fees increasing High staff turnover Obsolete equipment

AFRICARE Nutritional support on HBC Selection of beneficiaries is biased.

C. HIV prevalence rate

Organization Activities Gaps Ministry of Health

Limited staff IEC material is limited

Dutch -Behavior change communication to families with children less than 13.

House headed families are left

World Vision Activities in 3 wards only.

MACO -Workplace program Youth

Left Small to medium organizations, Ministries and Rural areas. Out of school youth program not fully established

D. Poverty

Organization Activities Gaps Oxfam -Livelihoods programs Low coverage only in 5 wards of Zvishavane.

Care -Small livestock -Small gardens

No livelihood program

World Vision -Dam construction and irrigation schemes for gardens -Livestock production

Catchment’s area is Mberengwa only Process is too long and expensive to maintain as stocks Need some treatments.

Save the Children

-Livelihood program-bee hive keeping -Life skills- basket making Small seed for gardens

The area covered is too small.

E. Water and sanitation Organization Activities Gaps

Zvishavane water project Dams, boreholes Coverage not enough

Oxfam Toilets, wells and dam Concept of ownership

World Vision Toilets Coverage area is small

Swot Analysis After analyzing MACO’s Macro and Micro environment as well as how other Stakeholders are operating their programs we managed to analyze its strengths, weaknesses, opportunities and threats.

Strengths Weaknesses Opportunities Threats

-Registration -Website -Balance board members -Stand procurement -Skilled manpower -Computerized accounting systems -Good documentation of programs -Good credibility for funding -Multiple networks e.g. ZAN,NAC -Use of local established structures -Database

-Limited transport -Inadequate program facilities e.g. HBC -Inconsistent Monitoring and Evaluation visits -No volunteer motivation (in urban) -Limited number of staff

-Potential of more funding due to donor confidence maintenance -Access to international funding -Organized and established community structures -Access to international funding

-Hyper –inflation -Political instability -Drought persistent -Unavailability of essential commodities -Unemployment -Floods

MACO‘s NICHE MACO is an AIDS service organization working in the area of HIV and AIDS prevention,

care and support

VISION

A well informed, responsive and capacitated community that is able to cope with the

impact of HIV and AIDS

MISSION STATEMENT

To offer HIV and AIDS prevention, care and support services to communities in Midlands

province so that they become responsive and able to generate meaningful coping

mechanism to identify healthy, livelihood and development challenges through active

participation of both the beneficiaries and service providers

CORE VALUES Transparency Accountability Commitment Integrity STRATEGIES In the next five years the following strategies will be used in all our programmes in order

for us to meet our objectives

1. Community mobilization

The communities will be mobilized to take an active role in HIV and prevention care and

support. The community entry point would be through local traditional, religious and

community leadership. The organization will also empower other community members

to be resource persons in any of the interventions

2. Capacity building

A skills transfer approach will be used to enhance the capacity of communities’ active

participation in HIV and AIDS intervention

3. Advocacy and lobbing

The origination thrives to create a conducive environment for people living with HIV and

AIDS orphans and vulnerable children, other vulnerable groups in communities.

Advocacy and lobbing will be used as a cross cutting issue to influence policy, practice

that promotes a conducive environment where there is acceptance and integration of

the sick, OVC into the community

4. Resource mobilization

MACO needs to be able to mobilize resources in order to implement this strategy.

Resources are scarce hence this strategy will assist in mobilizing human, financial and

material resources needed in the fight against HIV and AIDS.

5. Information dissemination

The organization will develop package and repackage information on HIV and AIDS and

distribute this information to targeted audience within communities. This is an ongoing

exercise

6. Service Delivery

MACO will offer counseling services, train community members on specific areas of

prevention, care and support, basic need, assist in the food and other water and

sanitation to the communities

ACTIVITIES MACO will run the following programmes

a. HIV and AIDS prevention focusing on the workplace, behaviour change,

youth in and out of school, voluntary counseling and testing

b. Home based care

c. Orphan and vulnerable children

Major Components

Activities Inputs Outputs Outcome Impact

HIV&AIDS awareness campaign

-Information dissemination -Drama -Poetry -Music -Dance -Posters -majorettes

-Youth -Marimba -P.A system -T/shirts -Stationery -Pamphlets

-Education -Entertainment

-Well informed community

-Reduced HIV prevalence rate

VCT -Community mobilization -Counseling

-Machines -Counselors -Transport -Posters -materials

-Number of people tested

-Eradication of stigma and discrimination -Knowing status

Workplace program

-Mobilization -Policy formulation -Peer educators -Material \cash -Training

-MACO’s staff training program -Program for government ministries -Counseling

-Facilitators -Stationary -Trainers and trainees -Materials for development

-Trained people -Materials developed -Peer counselors

-Eradication of stigma and discrimination -Well informed people

Behaviour Change

-Mobilization -Information dissemination - Meetings

- IEC material - T/ Shirts - Transport - Stationery - Posters

Number of meetings and mobilization sessions held.

Positive behaviour change

Reduced HIV prevalence rate

PPTCT -Mobilization -Post test support services

-Education -Counseling and testing -Treatment

-Counselors -Stationary -Trained staff

-Trained people

-Well informed community -HIV free babies

Youth in and out of school Psycho-social support

-Sporting activities -Training counseling

-Balls -Trainers -Transport -Stationery

-Socialism -Trained people -Physical fitness -Competitions held

-Accepting youth in the community -Unity of youth in the community

-Reduced HIV&AIDS prevalence

HBC -Home visits by youths(house chores)

-Transport -Youth -Gloves -HBC facilities -Disinfectants -Refreshments

-Number of families visited -Number if visits conducted

-Acceptance of youth in the community as caring and responsible

-Improved life standards

Income generating projects

-Gardening -Buying and selling -Variety shows

-Garden space -Seed and equipment -Capital -Marimba

-Gardens established -Quality of produce -Education -Noted income -Entertainment

-Economically empowered youth

-Improved life standards

Kids Clubs -Home visits -Sporting activities -Exchange visits

-Youth -Balls -Refreshments -Transport

-Service offered -Socialism -Education

-Acceptance of youth in the community and togetherness

B. HOME BASED CARE

Water &sanitation

-Sinking of boreholes -Upgrading of deep wells -Building of Blair toilets -Construction of water harvesting units -Small dams construction

-Trained personnel -Equipment -Capital -Tanks -Cement

-Boreholes -Small dams -Blair toilets -Water tanks

-Clean water -Better hygiene

-Reduction of water borne diseases -Improved quality of PLWHA

Shelter -Building and repairing of homes

-Manpower locally -Available building material

-Repaired completed houses

-Improved shelter

-Improved quality of life for PLWHA

Nutrition -Provision of food and herbs -Registered of vulnerable clients -Training volunteers and caregivers

-Food handouts stationery -Training manuals -Agricultural inputs e.g. seed - Herbal garden projects

-Food handouts -Balanced registered clients -Trained care givers and volunteers -Food -income

-Speedy recovery -Registered clients

-Improved health ,proper planning -Improved quality of life -Self sustainable independence

Volunteers (HBC facilities)

-Recruitment and training

-Training manuals -HBC kits -Reference manuals -Meaningful incentives(bicycles, uniforms)

-Trained care facilitators -Standard reference manuals

-Capacitated care facilitators Improved care

-Improved quality of life and care

Treatment -Post, test counseling -Investigation -Diagnosis -Management of OIs -Early institution of ART therapy -Follow ups

-Motor cars -Motor cycles -Bicycles -Fuel -Vehicle service -Log book

-Log book -Improved review system clients -Improved access to health institutions and beneficiaries

-Improved client support

Post test counseling and support services

-Post test counseling and adherence -Training in care and support -Support group formation

-Training -Peer educators -HBC kits -Care-givers

-Trained peer educators and counselors -Standard HBC kits.

-Improved/ better understanding of HIV/AIDS care and support.

-Improved client care

C. ORPHAN & VULNERABLE CHILDREN

Psycho-social support

-Counseling -Recreation -Camping -Exchange visits

-Child care officers -Furniture -Counseling

-Counseling registers -Distribution list -Log book

-Well integrated children

-Improved quality of life

equipment -Psycho-social support -Program vehicle -IEC material -Volunteers -incentives

-Registers

Vocational skills -Trainings (I.T) -Skills development -Financial support

-I.T department -Finance -Community artisans

-Trained OVC e.g. builder -Payment vouchers receipts

-Well integrated children

- Improved quality of life

Educational support

-Provision of uniforms books fees (Family grants) -Holiday lessons -Child sponsorship

-Finance -Uniforms -Teachers -Text books -Computer for internet services

-Receipts Clients register

-Well integrated children

-Improved quality of life

Economic Strengthening

-IGPs -Trainings -Financial support -Small Livestock

-Financial resources -Training material

-Training registers -Receipts -Vouchers -Training reports

-Well integrated children

-Improved quality of life

Advocacy -Training in gender issues -Child abuse -Wills &inheritance -Treatment -Identity -Child participation -Shelter provision

-Training material -Building material -Community volunteers

-Training reports -Treatment records -Gender balanced programs -Reduced case of child abuse -Increased cases of wills & inheritance reported -Completed shelter

-Well integrated children

-Improved quality of life

Water &sanitation

-Construction of toilets Rehabilitation & protection of water sources -Participatory health and

-Construction equipment training material

-Boreholes & wells

-Well integrated children

-Improved quality if life

hygiene trainings

Food & nutrition

-Food hampers provision -Farm mechanization -Trainings (nutrition & agriculture)

-Food hampers -Farm equipment -Training material

-Improved availability of quality nutritional food

-Well integrated children

-Improved quality of life

Treatment &Care

-Palliative care for children -Infant feeding -Provision of HBC kits for children

-HBC kits -Training material -Food for infants(milk)

-Quality care -Well integrated children

-Improved quality of life

D.MONITORING & EVALUATION M&E framework design

-Develop operational work plan -Develop M&E framework

-Stationery -Fares -Mileage -Refreshments

-Operational work plan developed -M&E framework developed

-A functional operational work plan and M&E framework

Accountability

Database setting/Establishment

-Develop data collection tools

-Stationery -Mileage -allowances

-Data collection tools developed and used for data collection

-Functional database available and regularly updated

Accountability

Training -Train staff on M&E

-Venue -Stationery -Refreshments -Allowances

-Number of staff and ancillary staff with M&E

-Effective M&E Accountability

Participatory review

-Conduct baseline surveys for OVC, care &prevention -Field M&E

-Stationery -Mileage -Allowances -Refreshments

-Situational analysis -Reports -Improved service delivery

-Informed programming -Effective implementation of programs

Accountability

Quarterly, annual participatory review

-Refreshments -Venue -Fares -Allowances -Mileage

-Improved service delivery -Stakeholders well informed

Re-strategizing Re-orientation

Accountability

D. ADMINSTRATION

Resource Mobilization

-Proposal writing -Meetings with

-Stationery -Transport

-Vehicle -Office space

-Facilitate smooth run of

-Reduce prevalence rate

funding partners fundraising

-Perdiems Accommodation -Fundraising

-Cash &kind programs

Governance Quarterly ----Board meetings -Board training

Transport -Sitting allowance -Signing allowance -Stationery Accommodation &meals

Quarterly ---Meetings held -Formation of constitution

Smooth -Running of working relations -Clear policies

Accountability

Human Resources

-Recruitment & selection -Staff welfare -Staff appraisals -Staff recreation -Trainings -Disciplinary procedure

-Adverts, staff profile Salaries/benefits -Stationery -Literature -Transport

-Vacancies filled -Well remuneration -Skilled staff -Well informed staff -Disciplined staff

-Posts filled -Motivation -Proper duty execution

Accountability

Asset management

-Insurance -Acquisition -Maintenance -Internal control

-Premiums -Acquisition policy/disposal -User manual –service kits -Procedure manual

-Insured assets -Acquired /disposed -Adherence

Risk reduction Accountability

Accounting -Financial report -Auditing -Payments -Procurement -Inventory -Book keeping

-Standard accounting procedures -Financial statements, fees -Payment policy -Procurement policy -Inventory policy -Accounting package

-Quarterly repots -Audited financial reports -Nil creditors -Purchased goods -Proper inventory system -Audit trail system

-Donor retention & increased fundraising -Donor confidence

Accountability

Essential support services

Payments of: -Rental -Phones -Rates -Water -Security fees

Service bills Service bills -Goodwill with service providers -Good public relations

Accountability

-ZESA -Canteen -Cleaning material -Entertainment

Costing Direct Beneficiaries H B C 36 000 OVC 30 000 YOUTHS 13 200 Total no of targeted clients 79 200 Standard cost for reaching out a client per year is calculated at USD 15 MACO has the following interventions; Prevention 30% Care 20% Support 15% M&E 10% Administration 25% HIV & AIDS Prevention Prevention 0.3 1,782,000.00 Home Based Care Care 0.2 1,188,000.00 Orphans and Vulnerable Children support 0.15 891,000.00 Monitoring & Evaluation M&E 0.1 594,000.00 Administration Admin 0.25 1,485,000.00 Total 5,940,000.00